Parents Increasingly Likely to Delay or Skip Vaccinations, Putting Children at Risk

AUGUST 13, 2012

Jeannette Y. Wick, RPh, MBA, FASCP

The pneumococcal vaccine is among the most commonly delayed, putting children and others at risk of deadly disease.
Some parents have concerns about vaccinating their children. They may choose alternative—and less vaccine-dense—immunization schedules, or skip some or all vaccinations. With reports of outbreaks of pertussis (whooping cough) increasing nationwide, many pediatricians are alarmed. Although parents have many reasons for delaying vaccination, most cite concerns that administering multiple, concurrent vaccines will harm their children. These concerns are unfounded.

To gauge the frequency of such alternative immunization schedules, researchers from the Oregon Health Authority analyzed medical records for 97,711 children in Portland, Oregon. Their results, reported in a study published online on June 18, 2012, in Pediatrics, showed that between 2006 and 2009, there was an approximately 4-fold increase in the portion of parents who consistently delayed or skipped vaccinations, from 2.5% to 9.5%.

By the age of 9 months, infants on alternative vaccine schedules had had 6.4 injections, compared with 10.4 injections for their peers whose parents followed the government recommended schedule. The vaccines most likely to be delayed by 9 months were those for hepatitis B and pneumococcal disease. Most children whose parents delayed vaccinations were unlikely to catch up with a complete vaccination schedule. Delaying certain vaccinations, and especially the pneumococcal vaccination, puts affected children and others at risk of deadly disease.

Portland schools have among the highest vaccine exemption rates in the United States, but there is reason to believe that the findings in the current study are in line with vaccination trends elsewhere in the country. Another study, published in Pediatrics in 2011, found that 13% of parents nationwide reported using alternative vaccination schedules.

The current study’s results showed that parents who consistently withheld or delayed immunizations, called shot-limiters, brought their children to the pediatrician for illnesses more often than those who followed recommended guidelines. These frequent visits to the pediatrician increased others’ potential exposure to communicable and vaccine-preventable disease. It also increased the amount of time the shot-limited children were susceptible to vaccine-preventable disease.

Just delaying the pneumococcal vaccine until age 2 puts a child at serious risk, since vulnerability to pneumonia is greatest from birth to age 1. Failure to administer the pneumococcal vaccine also increases nasal carriage of pneumococci and the risk of subsequent transmission to others who may be unable to receive the pneumococcal vaccine.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.